Bottle Feeding: Is There a Risk?

 

by Cynthia Billiar, RN, IBCLC, ANLC, ICD, ICCE

More than 85% of lactating women in the United States express their milk some of the time. Of those pumping, 5.6% are exclusively pumping and feeding by bottle, (Keim, Boone, Oza-Frank, & Geraghty, 2017). This is not surprising because we know that 70% of women with children under the age of 18 in the United States participate in the labor force, (“https://www.dol.gov/wb/stats/stats_data.htm,” 2016). Women who are actively serving in the United States Armed Forces make up 15% and this number continues to rise, (Feinstein, 2016).

The AAP recommendation is to exclusively breastfeed for the first 6 months, followed by continued breastfeeding along with complementary foods for 1 year, or longer, as mutually desired by mother and infant, (Eidelman & Schauler, 2012). Listed in order of least healthy to healthiest, the best feeding choices are first, direct breastfeeding, second, mother’s expressed milk, then human donor milk, and last, formula, (Mohrbacher, 2010, p. 236). Many mothers choose to exclusively pump and feed their breastmilk from a bottle for various reasons.

With the explosion of breast pump manufacturers and insurance companies covering breast pumps, exclusive pumping is becoming more popular, so much so, that it now has a nick name, “EPing”. We teach our expecting families the importance of looking at the risks, benefits, and alternatives before making any decision.  You can imagine there are many questions as to the risk of choosing EPing. Let’s start with the pump itself.

There are many different pumps and choosing the right pump can be confusing. Mothers respond differently to different pumps. There is a risk that the pump will not remove milk efficiently, causing an end result of low milk production. A recent study found that EPing is associated with a shorter milk feeding duration and an earlier introduction of formula compared to those mothers feeding at the breast and not pumping, (Keim et al., 2017).

Storage of breastmilk, whether in the refrigerator or freezer, is found to have a reduction of some of the cells and antioxidants, (Rasmussen & Geraghty, 2011).  When an Eping, mother does not get the skin to skin contact and closeness with her baby, the mother’s perception of stress and mood are affected negatively, (Mezzacappa & Katkin, 2002). This lack of closeness can also affect the bonding of mother and baby.

Next, let’s look at the bottles themselves. Bottles can increase the risk for future orthodontic problems, such as needing braces and the increase risk of cavities. Direct breastfeeding encourages better lower jaw development and stronger facial muscles, helping with speech development, (Bechtloff, 2012).

We also need to consider the risk of contamination and the time it takes to sterilize the bottles and nipples.  There are several studies that indicate feeding from a bottle causes babies to overeat, increasing the risk of obesity, (Li, Fein, & Grummer-Strawn, 2010).

The most interesting information I found was the studies that indicate there is a difference in the milk itself. Research demonstrates that when an infant is breastfeeding, and he has an infection, leukocytes specific to his infection increase in his mother’s breastmilk. The mechanism behind how the leukocytes move into the breast during an infant infection is unclear. One possible thought is that during breastfeeding saliva from the baby’s mouth is back washed into the mother’s breasts, which stimulates an immune response, (Hassiotou et al., 2013).  This protection in breastmilk is both antibacterial and antiviral. These immunities are lower in the nonexclusive breastfeeding dyad compared to the exclusively breastfeeding dyad, (Hassiotou & Geddes, 2014).

As you can see there are risks to EPing. There are times when a mother has no choice but EPing and I salute you. I know it can be very difficult to be an EPing mother, much more difficult at times than breastfeeding directly. The demands of this busy world can make life difficult but the strength and determination of a mother can withstand it all.

References
Bechtloff, R. (2012). 5 good reasons for breastfeeding your baby. Retrieved from http://www.bracesbylanghornechildrensdentist.com/5-good-reasons-for-breastfeeding-your-baby/
Eidelman, A. I., & Schauler, R. J. (2012, March). Breastfeeding and the use of human milk. Pediatrics, 129(3). Retrieved from http://pediatrics.aappublications.org/content/129/3/e827
Feinstein, L. (2016). 7 shocking (and sad) statistics on women in the military. Retrieved from https://splinternews.com/7-shocking-and-sad-statistics-on-women-in-the-militar-1793857140
Hassiotou, F., & Geddes, D. T. (2014). Immune cell-mediated protection of the mammary gland and the infant during breastfeeding. Advances in Nutrition. Retrieved from advances.nutrition.org
Hassiotou, F., Hepworth, A. R., Metzger, P., Tat Lai, C., Trengove, N., Hartmann, P. E., & Figueira, L. (2013, April 12). Maternal and infant infections stimulate a rapid luekocyte responds in breastmilk. Clinical & Translational Immunology, 2. https://doi.org/10.1038/cti.2013.1
Keim, S. A., Boone, K. M., Oza-Frank, R., & Geraghty, S. R. (2017). Pumping milk without ever feeding at the breast in the mom2mom study. Breastfeeding Medicine, 12(7). https://doi.org/10.1089/bfm.2017.0025
Li, R., Fein, S. B., & Grummer-Strawn, L. M. (2010). Do infants fed from bottle lack self-regulation of milk intake compared with directly breastfedinfants? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20457676
Mezzacappa, E. S., & Katkin, E. S. (2002). Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Retrieved from http://psycnet.apa.org/record/2002-00946-009
Mohrbacher, N. (2010). Breastfeeding answers made simple. Amarillo,TX: Hale Publishing.
Rasmussen, K. M., & Geraghty, S. R. (2011, August). The quiet revolution; breastfeeding transformed with the use of breast pumps. American Journal of public heatlh, 1356-1359. https://doi.org/10.2105/AJPH.2011.300136
Women in the labor force. (2016). Retrieved from https://www.dol.gov/wb/stats/stats_data.htm

Placental Encapsulation: Friend or Foe of Postpartum Mothers?

by Donna Walls, RN, BSN, ICCE, IBCLC, ANLC

In recent years, a practice has appeared which involves the preparation of a woman’s placenta for ingestion. Preparation practices vary from dehydration to heat treatments. The dried and ground placenta is then placed in capsules for ingestion over the first days or weeks after birth.  Some recipes can be found for the use of the placenta for making soups, stews or smoothies to be eaten after the birth. This controversial practice has been cited as a common custom throughout history and often referred to as part of traditional medicinal systems. Many proponents of placental ingestion report the benefits of less postpartum mood disorders, enhanced breastmilk production, treatment of anemia and encouraging uterine involution.  Another rationale for ingestion points to the common mammalian practice of eating placentas immediately after the animal gives birth. Most authorities agree that this practice seems to be done for protection of the offspring by removing the smell of blood which can attract predators and not for nutritional needs. This immediate consumption also allows for the normal physiologic function of lactogenesis. After the initial surge of ingested progesterone dissipates quickly over the first hours and days, the increasing levels of prolactin stimulate early milk production.

Research supporting the safety and efficacy of placental ingestion, placentophagy, has been scarce as most information is anecdotal. Suggested benefits of placental ingestion range from less postpartum depression and treatment of anemia to improving milk production. Concerns include possible low milk supply issues and unregulated, unsafe preparation practices resulting in contamination and possible infections.  A case of neonatal group B Streptococcus sepsis was recently reported to the CDC  . The Centers for Disease Control and Prevention then recommended that the intake of placenta capsules should be avoided owing to inadequate eradication of infectious pathogens during the encapsulation process The Association of Placenta Arts provides guidelines for patients and providers but at this time, there are no regulations for the safety in preparation or storage or standardization of amounts needed for therapeutic effects.

The low milk supply concerns can be explained by the physiology of early lactation. Placental progesterone fills and activates the receptor sites on the alveolar (milk making) cells during the pregnancy and is responsible for colostrum production in the last half of the pregnancy. At birth and with the expulsion of the placenta there is a dramatic, rapid drop in the progesterone allowing the receptor sites to empty of progesterone and fill with prolactin, the hormone responsible for milk production. Prolactin is released when the infant stimulates the nipple during feeding or nipple stimulation occurs with expression of milk.

There is no clear answer to the question of how much of the active hormone remains after the preparation process is completed. If the hormone is degraded, there may not be a negative effect on early milk production. If progesterone remains physiologically active there is a concern.  Only one study (Young et al, 2016) found that hormones did remain active and in levels high enough to cause a physiologic response.

In my professional practice as a lactation consultant, I have found a connection between mothers who have low milk supply and ingestion of placenta. Many of these mothers complained that they never really felt the initial filling, and when they expressed their milk, rarely pumped adequate milk to meet their infant’s needs.  They struggled with supply, even after adding extra feedings or expression sessions and often began supplementing when there was poor weight gain in the newborn period. There were enough cases noted that I added a routine question about the practice of placental ingestion to my history when working with mothers who have milk supply concerns. I have also found, within days, there was a filling of the breast and an increase in supply when the placental ingestion was discontinued.

So, how can we respond to questions? Should we be adding placental encapsulation education in our childbirth or prenatal breastfeeding classes? At this time we are still not assured of universal safety assurances or universal warnings. As ICEA childbirth educators we should encourage investigation and asking questions about the preparation process from those they are considering receiving placental products. We encourage our clients to consider risks, benefits and alternatives in many aspects of childbearing and we should also encourage then to apply the same principles to the possibility of consuming placental products.

References
https://www.nichd.nih.gov/news/releases/Pages/062615-podcast-placenta-consumption.aspx
Coyle CW, Hulse, KE, Wisner KL, Driscoll KE, Clark CT Placentophagy: therapeutic miracle or myth? Archives of Women’s Mental Health. (June 2015)
Beacock M (2012) Does eating placenta offer postpartum health benefits? Br J Midwif 20(7):464–469
Cremers GE, Low KG (2014) Attitudes toward placentophagy: a brief report. Health Care Women Int 35(2):113–119
Kristal MB, DiPirro JM, Thompson AC (2012) Placentophagia in humans and nonhuman mammals: causes and consequences. Ecol Food Nutr 51(3):177–197
Laura K. Gryder, Sharon M. Young, David Zava, Wendy Norris, Chad L. Cross, Daniel C. Benyshek 3 November 2016 Effects of Human Maternal Placentophagy on Maternal Postpartum Iron Status: A Randomized, Double-Blind, Placebo-Controlled Pilot Study
Joseph R, Giovinazzo M, Brown M. (2016 Oct – Nov). A Literature Review on the Practice of Placentophagia.  Nurs Womens Health; 20(5):476-483.
Young, S. M., Gryder, L. K., Zava, D., et al. (2016). Presence and concentration of 17 hormones in human placenta processed for encapsulation and consumption. Placenta 43: 86-9
Young, S. M., Gryder, L. K., David, W. B., et al. (2016). Human placenta processed for encapsulation contains modest concentrations of 14 trace minerals and elements. Nutrition Research 36(8): 872-8
Marraccini, M.E., Gorman, K. S. (2015). Exploring placentophagy in humans: Problems and recommendations. Journal of Midwifery and Women’s Health 60(4): 371-9
Hammett, F. S.  The effect of the maternal ingestion of desiccated placenta upon the rate of growth of the breast-fed infant. Journal of Biological Chemistry, 36, 569–573.
Gryder, L. K., Young, S. M., Zava, D., et al. (2017). Effects of human maternal placentophagy on maternal postpartum iron status: A randomized, double-blind, placebo controlled pilot study. Journal of Midwifery and Women’s Health 62:68-79
Farr A1Chervenak FA2McCullough LB2Baergen RN3Grünebaum A2. Human placentophagy: a review. Am J Obstet Gynecol. 2017 Aug 30. pii: S0002-9378(17)30963-8. doi: 10.1016/j.ajog.2017.08.016. [Epub ahead of print]
Hayes EH. Consumption of the Placenta in the Postpartum Period. J Obstet Gynecol Neonatal Nurs. 2016 Jan-Feb;45(1):78-89. doi:10.1016/j.jogn.2015.10.008. Epub 2015 Nov 25.
https://www.cdc.gov/mmwr/volumes/66/wr/mm6625a4.htm

SIDS Awareness Month

October is Sudden Infant Death Syndrome (SIDS) Awareness month and a time to take a fresh look at how we can educate parents and caregivers on reducing the risk of SIDS. According to the Center for Disease Control and Prevention (CDC), about 3,500 infants died in the United States in 2014 of Sudden Unexplained Infant Death. (SUID).

SIDS is the sudden death of an infant less than 1 year old that cannot be explained after a thorough investigation that includes a complete autopsy, examination of the death scene, and a review of the medical history. This is the most commonly occurring unexplained death of infants

Another definition to be aware of is Accidental Suffocation and Strangulation in Bed (ASSB) which is the sudden death of an infant less than 1 year of age that can happen because of:

  • Suffocation by soft bedding such as when a pillow or covers an infant’s nose and mouth.
  • Overlay, or when another person rolls on top of or against the infant.
  • Wedging or entrapment which is when an infant is wedged between two objects such as a mattress and wall, bed frame, or furniture.
  • Strangulation which can happen when an infant’s head and neck get caught between crib railings.

The original Back to Sleep campaign has been updated by the CDC and the National Institutes of Health to become the Safe to Sleep campaign. The campaign works hand in hand with The National Action Partnership to Promote Safe Sleep (NAPPSS) and other organizations to bring awareness to and provide education on SIDS and ASSB prevention.

Current research supports the following recommendation for SIDS risk reduction:

  • Always place babies on their backs when putting them to sleep for naps and at night.
  • Use a firm sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet.
  • Share your room with your baby, not your bed. Your baby should not sleep in an adult bed, on a couch, or on a chair alone, with you, or with anyone else.
  • Keep soft objects, such as pillows and loose bedding, out of your baby’s sleep area.
  • The risk of SIDS is even greater when a baby shares a bed with a smoker. To reduce risk, do not smoke during pregnancy, and do not smoke or allow smoking around your baby.

Absent from many of the messages is encouraging mothers to breastfeed, which confers a 50% risk reduction of SIDS, and an even stronger protection if the mother is exclusively breastfeeding. Recognizing that the sleep separately message can be confusing or difficult for breastfeeding mothers, the United States Breastfeeding Committee and NAPPSS worked with the American Academy of Pediatrics to develop a more “breastfeeding friendly” safe sleep message.

On October 24, 2016 the American Academy of Pediatrics announced their Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment.

The following recommendations were given supporting the updated policy:

  1. Breastfeeding is recommended to reduce the risk of SIDS and to enhance the health and well-being of the infant and the mother. The AAP recommends exclusive breastfeeding for 6 months (no formula, nutritional liquids or solid foods). Newer research demonstrates that exclusive breastfeeding can reduce the risk of SIDS by as much as 70%.
  2. Skin to skin care is recommended for all mothers and newborns, regardless of feeding or delivery method for at least an hour after birth
  3. Room-sharing with the infant on a separate sleep surface is recommended. Keep infants in close proximity to parents for the first 6 to 12 months of life.
  4. The AAP recognizes that parents may fall asleep in bed after or during feeding their infant, so remove pillows, loose blankets, loose sheets and move the bed away from walls to prevent entrapment, and follow remainder of safe sleep recommendations.
  5. Avoid nighttime feeding on couches and arm chairs which are not considered safe sleep surfaces at any time for infants.
  6. It is important that anyone who cares for the infant puts the baby to sleep on their baby on the back. Prone sleeping (sleeping on the stomach) increases the risk of rebreathing the same air that is under the baby’s face which can increase the levels of carbon dioxide in their blood, not enough oxygen in their blood which can be potentially fatal.
  7. Creating a safe sleep surface. Recommendations from the National Action Partnership to Promote Safe Sleep (in partnership with the AAP) recommends to:
    “Use a firm sleep surface, such as a mattress in a safety-approved crib covered by a fitted sheet, to reduce the risk of SIDS and other sleep-related causes of infant death. Firm sleep surfaces with no other bedding or soft objects. Nothing soft such as pillows etc. should be placed under the baby. Appropriate surfaces can include safety approved cribs, bassinets, and portable play areas. Safety approved cribs are those that have been manufactured and sold since the requirements went into effect on June 28, 2011. They have been designed to have the spaces between the bars too small for a baby’s head to get through and get stuck. Standards for other safety approved spaces such as bassinets, portable play areas and side cars (attachment to an adult bed that provides a separate, but close safe space) have also been developed by the U.S. Consumer Product Safety Commission, the agency that tracks accidents and deaths with products and helps keep babies safe from products that can be harmful or cause accidents. For information on safety standards for sleep products , contact the Consumer Product Safety Commission at 1-800-638-2772 or http://www.cpsc.gov.”
  8. Avoid smoking, alcohol, and drugs during pregnancy and after birth.
  9. Avoid devices marketed to reduce risk of SIDS such as monitors, wedges, devices or specific mattresses.
  10. Swaddling does not reduce the risk of SIDS and in some cases may increase the risk for overheating and SIDs.
  11. Consider offering a pacifier at nap or bed time, after breastfeeding is firmly established (no specified time frame). If the baby is not breastfed, then a pacifier can be introduced as soon as the family desires.
  12. Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.

Teaching points for prenatal or postpartum education on safe sleep include:

  • Exclusive breastfeeding significantly reduces the risk of SIDS.
  • Newborns and new parents sleep better when in close proximity.
  • Always place infants on their back for any sleep.
  • Do not allow any smoking in the home. Encourage and provide information to help women stop smoking during pregnancy.
  • Swaddling has not been shown to reduce the risk of and may increase the risk of overheating and SIDS. Avoid swaddling during times of sleep.
  • Do not use couches or chairs for nighttime feedings.
  • Do not co-sleep if either parent smokes or is using alcohol or drugs which can alter responding to the baby.
  • All surfaces that an infant might be sleeping on needs to be safe. This includes cribs, cots, playpens, and the parental bed (if the mother falls asleep while feeding). A safe sleep surface includes:
    • Firm mattress
    • Well-fitting sheet
    • No blankets or pillows
    • No bumper pads
    • Use only equipment designated and approved for infant sleep
    • No surface that can entrap an infant
    • No toys or pets sharing the same sleep surface
    • Avoid swaddling or clothing that can cause overheating

ICEA recently updated our Position Paper on Safe Sleep which is available on our web site.

References
http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938
Centers for Disease Control and Prevention . (2015). Sudden unexpected infant death. Retrieved August 20, 2015, from http://www.cdc.gov/sids/aboutsuidandsids
https://awhonn.files.wordpress.com/2015/10/tips-for-nurses-teaching-safe-sleep-in-the-hospital-setting.pdf
Pease AS, Fleming PJ, Hauck FR, et al. Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics. 2016-05-09 00:05:32 2016.
McKenna JJ, Gettler LT. There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping. Acta Paediatr. Aug 21 2015
Carpenter R, McGarvey C, Mitchell EA, et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies. BMJ Open. January 1, 2013 2013;3(5)

2018 Conference Abstract Deadline Extended

Share Your Expertise at ICEA’s Conference

Due to the recent fires and natural disasters around the world, there have been requests to extend the deadline for abstract submissions for our 2018 Conference. As a kind gesture, we’re extending the deadline to Monday, October 2.

The conference theme focuses on ICEA’s newly defined core values:

  • COMPASSION: We believe approaching maternity care with compassion and a nurturing spirit improves birth outcomes for all families.
  • COLLABORATION: We practice a culture of collaboration based on the knowledge that mindful engagement with diverse groups advances positive, family-centered maternity care.
  • CHOICE: We support freedom of choice by training professionals committed to empowering expectant families through informed decision making.

If you have an idea for a presentation centered around one or more of our core values, we’d love to hear it! We’re accepting submissions for concurrent sessions, hands-on skills stations, and poster sessions.

All abstracts must be submitted through the online system by 5:00 PM ET on October 2. Abstracts will then be reviewed by the ICEA Conference Committee. Share your expertise today!

If you have any questions about submitting your abstract, please contact the office.

Tips for Successfully Submitting Your Abstract

Submitting your abstract can be easily completed by following the steps below.

  • Create a profile on the submission site– please note that all submitters will be considered First-Time Users this year
  • Complete information about the author(s)-  including bio, headshot, and contact info
  • Share information about your session- including session description, session type, session level, track, etc.
  • Upload completed EPT and COI
  • Make sure to see the submission to fruition- you will receive an email confirmation for each session that you successfully submit

Submit Your Abstract

Credentials: What Are They and Why Do We Need Them?

What are credentials and why do we need them? Credentials include academic diplomas and degrees, identification documents, certifications, and badges to list a few. Theses credentials give proof of professional qualifications or background. Credentials may also inspire a level of respect. This is important to consider when you are deciding which school to attend or which organization to certify with. For example, when I decided to work toward my BSN (Bachelor of Science in Nursing) I looked for an accredited program – one that was reputable and authorized to educate nurses, one that was known for providing quality education.

These same considerations apply to professional certifications. ICEA began certifying childbirth educators in 1982. This year marks the 45th year that we have set the standard for birth professionals. ICEA has grown and developed programs that include Professional Childbirth Educator, Birth Doula, and Postpartum Doula programs. Our reputation for excellence has been recognized for decades within the communities of medical and birth professionals. Just this year, ICEA was awarded ANCC (American Nurses Credentialing Center) accreditation, meaning that we can now develop and present educational offerings for nursing continuing education.

Today, a variety of organizations offer credentials for childbirth educators and doulas, but few have the reputation for quality that ICEA enjoys. In the same way that hospitals seek accreditation from various agencies, they expect birth professionals to have credentials from organizations that they recognize and respect. ICEA’s longstanding history of family-centered, evidence-based care makes its credentials some of the most widely recognized and accepted – not only in the US, but around the world.  Our international reach continues to expand as we develop relationships with like-minded global partners.

ICEA ensures the quality of our credentials by requiring each candidate to pass an exam at the end of their course of study.  To maintain that quality each credentialed birth professional is required to obtain additional hours of continuing education in order to recertify. As research on best practices for pregnancy, birth, and breastfeeding continue to grow, we want to ensure that the knowledge of birth professionals certified by ICEA is current and evidence-based.

Becoming a credentialed birth professional is costly – in time, effort, and money – but it is worth it! ICEA credentials demonstrate your commitment to birth work. It is a verification of your professionalism, as well as the level and quality of your knowledge.

Recently, ICEA streamlined the membership and certification process. Our management company has worked diligently to make this process as smooth as possible, and we appreciate the ways in which you – the members of ICEA – have embraced this new framework. This tells us that you value what ICEA stands for – family-centered, evidence-based care – and that you value the ICEA credentials. We will continue to work hard to support and educate you as you flourish in supporting and educating childbearing families.

Flourishing for ICEA,

Debra Tolson, ICEA President and Bonita Katz, ICEA President Elect

Doula, Advocate, Activist

Most of us in birth work are well aware of today’s controversies in maternal health care: high cesarean rates, increasing maternal mortality, inadequate informed consent/refusal, lack of personal autonomy, and the list goes on.

These issues concern us – and they should.  We do this work because we care about mothers, babies, and their families.  And doulas are right in the middle of it all.  What is a doula’s role when a woman is in labor and it seems as though her wishes are not being honored? How does a doula advocate for her client?

Before we answer those questions we must remember some facts:

  1. In most instances, the woman chose her care provider and her place of birth. While it is possible to change both of those while she is in labor, that rarely happens.  And who is to say that the next care provider or place of birth will be an improvement? Most of the time you will have to work in the place and with the providers that the woman has already chosen.
  2. The woman is in labor. If a doula chooses to blatantly disagree with the care the woman is receiving she forces the woman into a decision.  Either she must choose her medical care provider over the doula (thus compromising the support the doula could offer) or she must choose the doula over her care provider (and so compromise her relationship with those delivering medical care).

So what can a doula do?  Encourage the mother and her partner to ask questions.  This does two things: First, it validates the soon-to-be parents as adults responsible for their own care and the care of their child.  This is their baby and their birth.  This is a key component of family centered maternity care.  The family makes the decisions that are right for them. Secondly, their questions may be an indication to their care provider that they need to communicate more clearly. Improving communication not only benefits the family, but it also improves customer satisfaction scores for the birth facility.

The doula herself can also ask questions. The recent update on doula care published by Evidence Based Birth (EBB) offers some welcome insight into client advocacy.  Good questions provide a way to ensure that the woman is aware of her options without negating the role of the healthcare provider. To quote the EBB article: “For example, if it looks like the provider is about to perform an episiotomy without the person’s consent: ‘Dr. Smith has scissors in his hand. Do you have any questions about what he is wanting to do with the scissors?’” Questions like this inform the woman (and her partner) and allows them to decide what to do with the information.

Doulas can advocate in this way for their clients, but how do doulas address those major controversies mentioned at the beginning of this blog? We must make a distinction between advocacy and activism.  Both are necessary, but they are approached in very different ways and in different settings.  Advocacy is described above and defined in the EBB article as “supporting the birthing person in their right to make decisions about their own body and baby.” Activism is taking on one or more of the big issues, researching and publishing the facts, and educating the public. Advocacy may take place in a clinical setting while the woman is in labor, but that is not the place for activism. Doulas advocate for one woman at a time.  Activism addresses an issue that affects many women.

Although a doula can be a birth activist, she must realize that activism may close some doors for her.  A birth facility may refuse her access if they do not appreciate her public stand on some issue.  Some have implied that birth workers must be activists in order to make effective change in maternal health care.  Activism will accomplish some change.  But so will the relationships that others build with health care providers.  The fact is that there are many ways to change the system.  We need activists… and we need advocates.  Let’s remember the difference and work within role we have chosen.

Resources
Dekker R (2017). Evidence on: Doulas. Evidence Based Birth. Retrieved August 23, 2017 from https://evidencebasedbirth.com/the-evidence-for-doulas/
Katz B (2017) One doulas difficult dilemma. International Journal of Childbirth Education. 32(3), p. 6.

Annual Membership Meeting Announcement

Notice is hereby given that ICEA will hold its Annual Membership Meeting on Thursday, October 19, 2017, at 1:30 PM ET via conference call. It is free for members to attend.

At this Annual Meeting, members will learn:

  • What the Board of Directors is working on
  • Who the 2018 Board of Directors will be
  • What has been achieved in 2017
  • What to look forward to in 2018

Time will also be given for members to pose questions to the board. Register now to be sent the call-in information. Space is limited to the first 200 registrants, so don’t delay. Register today!

If you are unable to attend the live call, a link will be sent out after the meeting for you to review.

Register Now